The Fractional Man

It was a dark and snowy night. That's quite rare in south Louisiana. And I was on duty.

Here, we consider snow like having a hurricane during an earthquake during a plague outbreak. No one was moving about that night. I did what any sensible ER type would do. I went for a nap.

I was awakened about 2 AM by the receptionist, saying "We've got a walk-in". Consciousness returned, and I went in. It's amazing how much you can see in the first seconds of an exam.

There, swaying slightly, stood a rather disheveled client. On his hip was a revolver. As a shooter, I notice such things. The revolver had rust and was in a very cheap holster. It was the sort of holster you'd see sold for a dollar on the junk table at a gun show. He also had a badge that said "Special Officer", also dollar gun show type thing.

As soon as I entered he started talking, rambling slurred words that only a drunk can do. He told me he was a US Marshall, in some detail. Look, I know Federal Marshalls socially and as clients. They are well groomed in public, not drunk. They hadn't carried revolvers in a generation. And I've never met a Fed, ever, who's sidearm was rusty.

So drunk? Check. Armed? Check. Liar? Check. I've handled drunks and don't mind guns. But combined they are dangerous. Add in liar, and I wanted him GONE. I was getting pissed.

It took several tries to divert him from the David Koresh ramblings. (The Waco standoff was in progress.) When I asked about why his dog was there, I got silence or "umms". To this day, I don't know why the dog was there. To speed things up, I tried asking multiple choice questions. Whatever I asked he always picked the "B" answer. On physical, the dog looked fine. I think I gave some pen and sent him out as fast as I could.

As I said, I was annoyed. I do not like people impersonating Federal agents. I decided to act.

I called the US Marshall's office and asked to speak to the duty officer. I told him I'd had a client impersonating one of their people. The agent said that was a serious allegation, and asked how I knew. I described the inebriation and dress, and the officer said it was possible that he was not a Fed. When I mentioned the rusty revolver, he said, "Nope, that's DEFINITELY not one of ours. I think we'd like to have a chat with him. Do you have any information on him?" Sure, I got the client info sheet, and gave the officer the client's name. Then we got to the address.

I had not looked at the address until then. "Holy crap!" I said. The duty officer asked what was wrong. I caught my breath. "Let me explain to you that I am not the drunk here. I'll be happy to hand you a copy of this or fax it to you. But I am not making this up.", I said. "Sir what are you talking about?" "It's his address. It's PO Box 0423 1/4". No that is not a typo. The drunk wrote down box 0423 and a quarter. The officer said "Sir? Are you kidding?"

We faxed the sheet. When he got it, the officer said, "Holy crap, you were telling the truth!" I asked what next. The officer promised that they would find the client, and he promised that if I ever saw him again, he would not be drunk, nor armed, and that he would never, ever claim to be a Marshall again.

That suited me. I went back to bed. But to this day, I still wonder what sort of conversation the man with the fractional address had with the real Marshalls.

Speaking of Veterinary Economics....

I read this today http://www.abcmontana.com/news/local/Budget-Would-Fund--170275226.html. Apparently the state of Montana is considering starting a new vet program.  This press release quotes Montana State University College of Agriculture Dean Jeff Jacobsen as saying, "There is a workforce shortage of veterinarians practicing large animal in Montana."

Yeah?  Why is that?

It's not a lack of veterinarians!  

There are enough veterinarians willing to practice in rural areas.  

Maybe if I say it again:

There are enough veterinarians willing to practice in rural areas. 

Maybe if I type it real slow: 

T  h  e  r  e    a  r  e    e  n  o  u  g  h    v  e  t  s . . . 

Maybe if an expert says it. A bunch of them, actually.

The American Association of Bovine Practitioners (AABP) (national professional organization for cow vets) made this statement in May 2011:

" there is not currently a shortage of veterinarians for rural food supply veterinary private practice....Efforts to increase interest in rural practice among graduating veterinary students have been successful, so lack of available veterinarians is no longer an issue... there remain underserved rural areas across the country that may not be able to sustain a veterinary practice... The committee is extremely concerned that the perception by veterinary schools and the public that there continues to be a shortage of rural practitioners is leading to increased class sizes at veterinary schools and the creation of new veterinary schools.  Continuing to increase the number of veterinarians interested in serving rural areas will not solve this problem."

 

Figures the guys who remove testicles for a living would have enough to come out and say that.  I'm not hearing it anywhere else.

 

I mean, really- the people who make a living doing it are saying, basically, there's not enough money in some places to make a living doing it. 

 

So what the hell kind of sense does make to to crank out ten more heavily indebted* new grads every year to do it in those very places?!?!!?

 

Especially since there's not much proof that a state's students will come back to that state to practice.  

Much less farm kids.

 

I married a guy who grew up on a farm.  He'll tell you, there's a reason he went to college.  It wasn't so he could go back to the farm and pull calves in the 20 below dead of night.  Very few people are going to put themselves six figures in debt for that.  And they're damn sure not going to put themselves six figures in debt to do it for chicken feed. 

Will educating kids from Montana mean those kids will come back to Montana to practice large animal?  Especially if there's not enough money for them to get paid for it?  

Must be nice, spending other peoples' money. 

Seriously, if I were a Montana taxpayer I would reeeeeallllyy want to see some independent financials on this.  Would the state not be better off taking the money that's going to go into this program and paying vets to provide services in those areas, or hire techs or some sort of paraprofessional to work with existing remote vets, or set up telemedicine, or, well, ANYTHING a little more certain to achieve the goal of filling the gap?  As a staunch free market adherent those words make me cringe but I have to say them.  For animal welfare and biosecurity purposes we can't let large areas go without some kind of veterinary presence.

The reason there are areas of Montana, and the rest of the country, that lack a veterinary presence is because there's not enough money in those areas to pay a vet, and not enough reason to go be a vet there even if there were plenty of money.  See above about pulling calves in the 20 below dead of a Montana night.  

Think that's cold?  How 'bout 40 below?  Because Alaska is proposing a new program to produce 20 a year, in collaboration with Colorado State. This article from a Fairbanks paper last year  quotes a Fairbanks veterinarian as saying the shortage of vets there leads to burnout and high turnover. Typically, labor shortages lead to high wages and lots of work which leads to happy veterinarians; it's crappy working conditions and a lack of clients wiling to spend money that lead to burnout and high turnover.  Even if there were a shortage... does Alaska need 20 more vets every year?  Really? There's enough paying work for TWENTY MORE VETS in Alaska every year, year after year?

And Utah is accepting it's first class of 30 this fall, to spend their first two years in Logan and the last two in Pullman at good ol' Washington State.  Not to be a hater, but there's no way Utah needs 30 more vets each and every single year.  It's Utah.  I'm unaware of it being a huge agricultural power and a major population center.  

I haven't even mentioned the new schools that are supposed to be starting in Arizona and Tennessee at over a hundred students apiece every year.  Or the bigger classes at lots of the established schools...

So I guess the takeaway for me is that it doesn't seem like the profession is working as a system.  The schools aren't hearing what we as practitioners are saying.  The VMAs certainly don't seem to be saying much to the states.  The AVMA can't figure out what it ought to be saying.

I hope things start getting better soon, but with the tsunami of new grads hitting the market, and the livestock markets dropping like a rock because of the drought, things are maybe going to get a lot worse instead.  I don't know what to do other than this. I'm scared for my future.

 

Sincerely, 

 

Dr. Who-the-hell-runs-this-joint-anyway-oh-*&^%-its-us

 

* Well, they will be slightly less heavily indebted.  Spending the first year at Bozeman instead of Pullman means $14,000 instead of $39,000, according to the colleges' websites.  I grant that $25,000 isn't chicken feed, but it's not exactly a huge reduction of the $160,000 tab these kids are looking at running up before they graduate.  Well, more than that if you count inflation- Washington State's tuition went up over 6% this past year.  Plus there's interest while you're in school now.  Fabulous!

Guest post: Dear whoever you are

Dear hysterical lady who calls literally in the middle of the night: 

1) I cannot understand hysterical crying, whether in a voicemail or while on the phone. 

2) Calling 4 times in 5 minutes does not necessarily get me to call back any faster, especially when (#1) applies. I need to understand your phone number at the very least.

 3) $150 plus euthanasia costs is not "insane" (thanks insensitive husband in the background) when I'm the one getting woken up in the middle of the night to take care of a cat that you "don't think" I have ever seen before in my life.

4) "Do you live here in town?" The location of my residence relative to the hospital does not get you a reduced emergency fee.

5) I really do hope he passes quickly so the trauma stops, because I feel bad that you are hysterical, and it doesn't sound like your husband is going to "let" you bring him in.

After this call, it's to the couch I go so I don't keep my fiancé up for the next 2 hours that I won't be able to sleep.

Hearing voices?

Like many other professional offices, VBB Central has a television in the waiting room. Generally, ours is tuned into something relatively benign - the local news, one of those annoying morning shows, or a loop of animal-health-related videos. It's not something I ever really pay any attention to.

Today, when I walked into the building, the caught my attention. You know those TV ads by ambulance-chasing lawyers? Where you have this vaguely ominous sounding guy saying "Have you ever experienced night sweats, disfiguring acne, and crippling toe pain? If so, and you've taken mistakeomycin, CALL IMMEDIATELY, to take part in a class action lawsuit! ONCE AGAIN, if YOU have SUFFERED THE EFFECTS of MISTAKEOMYCIN, PICK UP THE PHONE AND CALL NOW!" Well.... I heard a similar type of ad this morning. I looked at the TV & saw what appeared to be a row of beds in a hospital taking up half the screen, and some text scrolling on the other side. The voiceover was the same vaguely ominous sounding guy from the lawyer ads, but he was soliciting patients for some kind of research study at a local hospital. He was saying something along the lines of "are you between the ages of 18-25? Have you been diagnosed with schizophrenia for at least the past 2 years? If so, PICK UP THE PHONE and CALL NOW to enroll in our new study! Again, if YOU are suffering from SCHIZOPHRENIA, don't delay! PICK UP THE PHONE and CALL NOW!"

I swear to dog, all I could think was "OMG, some dude with schizophrenia is going to call his psychiatrist and tell him his TV is talking to him, and the psychiatrist won't know that the dude's TV *was actually talking to him!*"

I don't know, it just seemed to me perhaps not the best method of recruitment for patients with this truly tragic illness.

Do you have a mouse in your pocket?

I recently had the very great pleasure of being presented with a dog for the purpose of emptying his anal sacs. His owner informed me that he'd brought the dog in several days prior, and a licensed tech had done the sac-emptying, but maybe didn't do a good job because the dog was still scooting. So, I assessed the situation digitally, as one does in these circumstances, and I found that in fact the sacs were empty. "Guess what, TBB? You actually did a great job! These are empty! Now let's see...." I said, as I looked for another cause of scooting in this pup. "Aha. See that little protrusion there, sticking out from the dorsal rim of the anus, where 12 o'clock would be if this were a clock?" I asked the owner. The owner expressed agreement that yes, there was something there. "Well, I'm not 100% sure what that is, but it's only about 2 mm wide, and it's on a less than 1 mm wide stalk, and it's a tiny bit irritated - this could be the issue." I gave them some cream to put on it and explained ultimately we could just remove it if it continued to be a problem.

About an hour or so later, the owner's other half called me. I was instructed to take the call.

Me: Hello, this is Dr VBB, how can I help you?
Mrs. Knowsit: Yes, my dog and my husband were just there. Why didn't you run a fecal?
Me: Oh, you mean on little Fluffypants, with the scooting problem? Well, you didn't send in a fecal sample, and I didn't feel one was indicated for any reason, so I didn't do one.
Mrs. Knowsit: but obviously she has worms, she is scooting.
Me: That doesn't mean she has worms. It could be something else.
Mrs. Knowsit: well, but most likely it's worms. I just don't understand why you didn't do a fecal.
Me: I don't believe she has worms. A fecal was not indicated. She's 12, she's on a monthly dewormer, she's never had clinical signs referable to worms before, and she has a perfectly reasonable cause for scooting in any case.
Mrs. Knowsit: Oh? What's that?
Me: The mass on her anus.
Mrs. Knowsit: The what?
Me: The mass on her anus, it was a little inflamed.
Mrs. Knowsit: (laughing) I've never heard it called that before!
Me: What do you mean? You've never heard a mass called a mass, or you've never heard of a mass being called inflamed? Sorry I don't understand.
Mrs. Knowsit: Wait a minute. A mass? I thought you said she has a mouse on her anus.
Me: No. Your dog does not have a mouse on her anus.
Mrs. Knowsit: OK. But I still think she has worms.
Me: I'm more than happy to run a fecal for you any time. Just drop off a sample at your convenience.
Mrs. Knowsit: Ok, thank you doctor.
(click)

The fecal was duly dropped off and was run. GUESS WHAT? It was negative. But how much do you want to bet that this client will tell me she doesn't want to spend whatever my next recommendation was cost because she just "had to" spend "so much money" on a fecal? HMMM? I did try to avoid taking her money for the fecal. Honest.

Ball Bells

Well gang, this is my first post to VBB.  I have been hanging around VBB Cental for awhile, and they finally decided I was warped enough to contribute.  Let the games begin!

Speaking of doing things with testicles...(which we do at VBB Central) a good friend and client of mine gave me a little gift one Christmas.  I had neutered her beloved dog, Murphy.  Being the great veterinarian and friend that I am, I place those BIG buggers in a formalin jar, and sent them home as a parting gift.  Little did I know that they would come back to me, along with this cute poem.

A couple of Christmas ornaments for you to put on your tree.
You may remember seeing these before, you took them from me!
I saved them for a little while hoping they might bring me luck,

But look what happened to them - they all shriveled up!!!
I can no longer lick them and that really sucks
And I've come to realize now I can't even F**K!
So I'm passing on to you my little holiday nuts
Maybe as a warning to all those other mutts,
Who come thru your clinic door to see you Dr. No
This this maybe the last time they lift their leg to go!
I do hope you enjoy these little Christmas bells,
And thank you for taking care of me so well!
My little sac is now empty, a little fuzzy pouch,
My pecker no longer dribbles so I can now lay on the couch.
They'll no longer get blue or make me run away,
So thank you Dr. No and have a Happy Holiday!!

Love, Murphy

Yes, it was painted and glittered!

Motivation?

I don’t know… how old are you in the fourth grade? My three friends were that old, and I was one year younger, for those people who determine these things had jumped me up a grade already for some god forsaken reason. As social development matters, I paid the price for that compliment throughout the rest of my childhood. But I was hanging with my older friends, and we were down at the horse barn, throwing rocks at the pigeons and looking for stuff to steal or wreck, and generally wasting our mid-summer youth in an age appropriate manner. That’s when we found the kitten.

It was probably 5-6 weeks old, and even we children could see that it wasn’t doing well. That veterinarian part of me remembers it as probably dying from feline distemper, but of course I didn’t know that then. But even as children we could see that the kitten wasn’t doing well. It was clearly dying. And we figured it was suffering. And we determined, via a quick huddle, that our parents weren’t gonna help, for they had far more important things to do. So we figured the job had fallen to us, and we needed to come up with a way to put this suffering kitten out of its misery. 

So we looked around the horse barn for anything that might get this job done. Not surprisingly, we found no barbiturate euthanasia solution, no IV catheters, no sedative drugs, none of the tools I can call upon now. Instead we found a nail, some string, and a stout wall. If you are squeamish, you can skip the rest of this paragraph. Anyway, we failed to euthanize this kitten by piercing its chest with a nail. We failed when we tried to hang it. And when we finally, out of frustration, or ineptitude, or perhaps some primal predatory rage thing, we flung the kitten against the wall until it was quite dead.

At some point in this process, I began to feel quite wrong. But I did get caught up in this thing, and I participated. The older kids were quite into it. And they urged each other, and me, on. Oh, I felt bad about it. I felt bad about it while it was still happening, and that night, and other nights after, and from time to time late at night since… I still do.

When people ask me why I became a veterinarian, I don’t mention this day. By all the odds this day should have landed me in the role of serial murderer or at least a personal injury lawyer. But no…years later I enrolled in veterinary school, and I’ve been working assiduously at this endeavor since. 

Am I making it up to this kitten, or did I actually have a few other motivations to follow this path? I think I had other significant reasons to do this work, but yes, I do think of this kitten from time to time. And every time, despite all I know and all I can do, I fail to save a kitten, I suspect I do feel the presence of that one kitten that I once tried so hard to help, and instead created horror and fear and pain. And I die a little again, and again. Late at night. 

Like now.